A Fourth Painkiller Is Linked to Increases in Heart Problems
December 21, 2004
By ALEX BERENSON
The future of Celebrex, the best-selling arthritis pain
medicine, may be determined as much by Dr. Jason Faller and
other physicians treating arthritis patients as federal
Even if regulators do not force Pfizer to withdraw the drug
from the market because of heart attack risks, its
prospects are dim if doctors stop prescribing it in the
volume they have in recent years.
Dr. Faller, chief of the arthritis clinic at Roosevelt
Hospital in New York, said that about 25 percent of the
clinic's patients now took Celebrex. Over time, he
predicted that number would probably fall to about 5
"Certainly I will be disinclined to start patients anew on
the drugs," Dr. Faller said. Still, he said Celebrex and
Bextra, a similar arthritis drug also made by Pfizer which
has also raised heart attack concerns, provide a useful
alternative for some patients who are not helped by older
over-the-counter drugs like ibuprofen, the generic name for
Reflecting the medical community's concerns about Celebrex
and Wall Street's increasingly negative view of the drug's
prospects, shares of Pfizer fell nearly 6 percent yesterday
after plunging 11 percent on Friday. Even so, some
investors said that the sell-off appeared to have gone too
far, particularly because the Food and Drug Administration
has not said it would order the drug withdrawn.
On Friday, Pfizer said that a study had found that high
doses of Celebrex taken for long periods were associated
with a sharply increased risk of heart attacks. On Sunday,
under pressure from the F.D.A., Pfizer said it would
suspend all consumer advertising for Celebrex.
The company says it plans to continue selling the drug
because it maintains that there is no evidence that
Celebrex is unsafe at lower doses or for shorter periods.
In heavy trading on Monday, Pfizer shares fell $1.46, or
5.6 percent, to close at $24.29. Pfizer has lost almost $35
billion in market value since it disclosed the results of
the study on Friday morning.
David Katz, the chief investment officer of Matrix Asset
Advisors, which manages about $1.5 billion, said the
decline reflected Wall Street's panic over potential
product liability lawsuits rather than a careful
calculation of the real impact of the Celebrex problems on
Pfizer. Matrix owns 2.2 million Pfizer shares and plans to
buy more, Mr. Katz said.
Even if the F.D.A. forces Pfizer to stop selling Celebrex
and Bextra entirely, he said, Pfizer shares have fallen too
Many scientists and analysts said that the market for
Celebrex would shrink quickly because it had shown little
benefit over older and much cheaper pain medicines even
before Friday's announcement. Without a clear benefit, they
said, even a small heart risk will discourage doctors from
Combined sales of Celebrex and Bextra, a similar arthritis
drug also made by Pfizer, are expected to be more than $4
billion in 2004, about 8 percent of Pfizer's worldwide
sales. But sales will probably plunge next year, said
Michael Krensavage, an analyst at Raymond James. "Unless a
patient is at risk for a bleeding stomach, the drugs are
just not worth the money," he said.
In a research note yesterday, Richard T. Evans, an analyst
for Sanford C. Bernstein, predicted that total sales of
Celebrex and Bextra would fall from $4.2 billion this year
to $775 million in 2007. As a result, Pfizer's overall
sales will drop, from $51.1 billion this year to $46.5
billion in 2007, Mr. Evans said.
Both Celebrex and Vioxx, a similar medicine which Merck
stopped selling in September after it was linked to heart
attacks, are generally no more effective than
over-the-counter medicines, said Dr. Marcia Angell, the
former editor of The New England Journal of Medicine.
"There was never much reason for these drugs in the first
place," she said. "So one should accept virtually zero side
effects from these drugs."
But Dr. Gail Cawkwell, who directs Pfizer's medical
research on Celebrex and Bextra, said many patients
benefited from the drugs. "Celebrex still has some
significant benefits over the older medicines," she said.
"We've had a lot of support from doctors saying they have
patients who haven't responded to anything else."
In the meantime, analysts expect Pfizer to earn about $2.10
a share next year, which means the company is now trading
at less than 12 times its projected profits. That multiple
is quite low considering that Pfizer has the financial and
marketing strength to buy up or be a partner with almost
any other drug company in the world, Mr. Katz said, adding
that "the stock is at a great price under every scenario."